Abstract
Sweden constitutes a traditionally well-developed system of long-term care, based on tax-funded, mainly publicly provided services. This system has changed significantly in recent decades. There has been some retrenchment in eldercare evident in falling coverage and stronger targeting of people with higher levels of need. This development has led to the informalization of care for some groups of older people. In disability care, there has been a considerable expansion of services, perhaps most notably in the introduction of a personal assistance scheme for people with severe disabilities. These divergent trends in services for older people and people with disabilities have coincided with a convergent development across both care fields: the marketization of services and the emergence of large, corporate, for-profit providers. This chapter explains how and why these changes have happened, and their consequences for service users and for the possible future of social care in Sweden. In addition to the dynamic interaction of state-steering and municipal response that are typically important in explaining change in patterns of social service in countries with multilevel government, “invasive displacement” and “layering” are identified as processes transforming the institutions that directly and indirectly organize care service provision.
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- 1.
Three groups are specified in the Disability Act: (1) persons with an intellectual disability, autism, or a condition resembling autism; (2) persons with a significant and permanent intellectual impairment after brain damage in adulthood; and (3) persons with other lasting physical or mental disabilities (not due to normal ageing) if these disabilities cause significant difficulties in daily life requiring extensive support.
- 2.
Childcare is another area where increased government ambitions have reduced the municipal resources available for eldercare: with the implementation of the School Act 1995, municipalities became obliged to offer childcare to all children 1–12 years of age. As a result, between 2000 and 2009, the public resources for childcare increased by 67 % (National Agency for Education 2011).
- 3.
Also, after the actual tax-freeze several government initiatives have imposed restrictions on the municipalities’ decision latitude in raising tax rates. For instance, between 1997 and 1999, municipalities that raised their tax forfeited government grants equivalent to half of the increase in revenue (Palme et al. 2003).
- 4.
In Sweden, a parliamentary commission usually is appointed to investigate an issue before a Government Bill is put to the Parliament. The commission presents one or more Government Reports, which are discussed widely during a consultation process designed to provide feedback to the Government. Bills are drafted after the consultation process has concluded (Ministry of Justice 2007).
- 5.
People who begin to access services before they turned 65 are allowed to keep the (typically much higher) level of provision under the Disability Act, rather than be moved into the eldercare system. However, if they have personal assistance, they are not permitted any increase in the service offering, even if their needs change.
- 6.
The study also found that LSS spending also crowded out spending on education, but did not crowd out spending on other municipal social responsibilities, including childcare, social assistance, and culture and leisure activities (Birkelöf 2009).
- 7.
Younger disabled people with smaller care needs who are not eligible under the Disability Act rely, similar to older people, on services under the SSA, or on informal or market care, and they have been similarly affected.
- 8.
Particularly important was the 1987 Long-Term Survey, which suggested both limits on taxation and the introduction of market mechanisms such as a division between purchaser and providers and that private companies should be able to compete with public providers. The argument was that “the consumers’ free choice will show under which organizational forms an activity is best provided according to the consumer’s wishes” (Government Report 1987, p. 178).
- 9.
The same Minister was responsible for both issues, the Minister of Civil Affairs, Bengt K.Å. Johansson, former Assistant Minister of Finance.
- 10.
In contrast to the “real” market, the price is set in advance; thus the providers are expected to compete only with quality.
- 11.
As the deduction is offered to all purchasers of domestic and care services, without needs assessment, it is not possible to determine whether these purchases are a direct substitute for publicly subsidized services offered via the formal care system.
- 12.
As measured by a higher proportion of residents with university education and a higher tax base, both of which correlate to higher average household incomes.
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Meagher, G., Szebehely, M. (2013). Long-Term Care in Sweden: Trends, Actors, and Consequences. In: Ranci, C., Pavolini, E. (eds) Reforms in Long-Term Care Policies in Europe. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4502-9_3
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